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General NPI Number Information
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NPI Number | 1366453482
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Entity Type | Organization
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Legal Business Name | LITTLE CREEK COUNSELING CTR
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1709 COLLEY AVE STE 311
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City | NORFOLK
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State | VA
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Zip | 23517
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Country | US
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Telephone | 757-628-8337
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Fax | 757-628-5911
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Provider Business Mailing Address
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Address Line | 1709 COLLEY AVE STE 311
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City | NORFOLK
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State | VA
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Zip | 23517
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Country | US
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Telephone | 757-628-8337
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Fax | 757-628-5911
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NANCY TAYLOR MITCHUM
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Credential | PSYD LCP
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Telephone | 757-628-8337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810002730
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License Number State | VA
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